Form Center

Outreach Request Form

2. Outreach Request Form Instructions
   The St. Charles County Police Department welcomes invitations to share safety presentations and equipment/vehicle demonstrations at community events, churches, and schools. To request our attendance at your next event, please complete and submit the below form. Your request is appreciated three weeks in advance.
   
   If you have questions, please contact Val Joyner, public affairs officer, at 636-949-3057 or vjoyner@sccmo.org. Thank you for your invitation.
4. Event Title
6. Event Date and Start/End Time
   Event Date and Start/End Time Start Date

   Event Date and Start/End Time Start Time

   —

   Event Date and Start/End Time End Date

   Event Date and Start/End Time End Time
8. Event Location
10. Address
12. City
13. State
14. Zip
16. Event Summary/Overview
18. Event Purpose
20. Estimated Attendance
21. Audience
    -- Select One --Pre-SchoolElementaryPre-TeenTeenAdultSenior
22. Event Open to the Public

    1. Yes
    2. No
24. Is media invited

    1. Yes
    2. No
25. Has media confirmed

    1. Yes
    2. No
26. SCCPD Requested Resources
    Examples: Community Education, K9 Bonnie, Safety Presentation, etc.
28. Organization Requesting Resources
30. Requester Name
31. Requester Email
32. Requester Phone
34. Event Day Contact Name
35. Event Day Contact Email
36. Event Day Contact Phone
38. Link to event website or social media page
39. Event Flyer
41. What other community partners are involved?
42. Additional Details
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field